What is MS
an inflammatory dymelinating disorder of the CNS with plaques the disseminated in time and place
what is the common epidemiology of MS
more common in females
usually presents in 30s and 40s
more common in countries further away from the equator
What is the aetiogy of MS
Small genetic predisposition - 2 percent of people with MS have children with MS
What are the differenty types of MS
Relapsing remitting - most common
Secondary progressive - 60 percent of RR pts will develop this in 10 yrs
What kind of symptoms can present with MS
pretty much anything! Pyramidal dysfunction Optic neuritis sensory symptoms Autonomic dysfunction cerebellar and brain stem features cognitive impairment fatigue
What pydramidal dysfunction occurs in MS
Increased tone Spasticity Weakness Extensors of upper limbs Flexors of lower limbs
What is optic neuritis
Inflammation of optic nerve
Painful vision loss. 1-2 weeks then returns
What sensory symptoms can occur
Pain paraesthesia Dorsal column loss - proprioception and vibration Numbness trigeminal neuralgia
What can occur in cerebellar symptoms
ataxia intention tremor nystagmus past pointin pendular reflexes dysdiadokinesis dysarthria
What brain stem dysfunction can occur
sixth nerve palsy –> diplopia
facial nerve palsy–> facial weakness
what immune cells mediate MS
what is internuclear opthalmoplegia
Internuclear ophthalmoplegia (INO) is a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction.
What is the result of internuclear opthalmoplegia
medial longitudinal fasciculus distorted binocular vision Diplopia (due to failure of adduction) Nystagmus Lag
What urinary tract dysfunctions may occur in MS
frequency nocturia urgency urge incontinence retention
How is fatigue in MS managed?
Modafinil if sleepy ( it is a eugeroic used in narcolepsy and sleep disorders)
What are the diagnostic criteria for MS
Must have at least 2 episodes suggestive of demyelination.
Dissemination in time and place.
McDonald criteria is used to diagnose MS
What investigations are used to help diagnose MS
Neurophysiology ie EEG
What is an evoked response?
an electrical potential recorded from the nervous system of a human or other animal following presentation of a stimulus as detected by an EEG.
What is VER and SSEP
VER= visial evoked response
SSEP= somatosensory evoked potential
VER delayed in MS
What may be found in the CSF of MS patients
In 90 percent of cases there is oligoclonal bands present
Can be absent.
What is CIS
clinically isolated syndrome
ie ONE episode of neurological dysfunction suggestive of demyelination
CANNOT BE MS UNLESS THERE HAVE BEEN AT LEAST 2 EPISODES- note PPMS is different